'Sc.a.x'IcV  r‘ 


%t  «-r. 


pllpiill^ 


i^HS 


•-  < 


1 islSlS* 

:M$WiM 

i«i 


mmummmm 


stihEM&Swy, 


SCARLET  FEVER. 

(SCARLATINA) 

ITS 


Prevention, 

Restriction  and  Suppression 

PUBLISHED  BY 


The  Illinois  State  Board  of  Health. 
1911. 


REVISED  EDITION. 


Please  Preserve  for  Future  Use. 


Should  a case  of  Scarlet  Fever  occur  near  you,  you  can  do  yourself 
and  your  community  great  good  by  seeing  that  the 
family  has  one  of  these  pamphlets 


Copies  can  be  obtained  by  any  resident  of  Illinois,  without  cost, 
by  addressing  the  Secretary  at  Springfield. 


SPRINGFIELD,  ILL. 

Illinois  State  Journal  Co.,  State  Printers 
1911. 


“Better  that  we  should  err  in  action  than  wholly  refuse  to  perform. 
The  storm  is  so  much  better  than  the  calm,  as  it  declares  the  presence 
of  a living  principle.  Stagnation  is  something  worse  than  death.  It  h 
corruption  also.” — Simms . 

* * * 

“No  man  should  be  so  much  taken  up  in  the  search  of  truth,  as  therein 
to  neglect  the  more  necessary  duties  of  active  life ; for  after  all  is  done 
it  is  action  only  that  gives  a true  value  and  commendation  to  virtue.’ 
— Cicero. 


(o 


SCARLET  FEVER. 

(From  NothnagePs  Encyclopedia  of  Practical  Medicine.) 

In  none  of  the  acute  exanthemata  does  our  lack  of  knowledge  of  the 
cause  of  the  disease  prove  so  disturbing  a factor  as  in  scarlet  fever.  A 
clear  conception  of  the  processes  that  take  place  in  the  body  in  its 
course  is,  on  account  of  this  fact,  rendered  in  every  respect  considerably 
more  difficult,  and  in  many  particulars  altogether  impossible.  The  out- 
ward-manifestations of  the  disease  are  very  various,  and  its  inward 
nature  must  be  an  analogous  one.  Otherwise  it  were  hardly  conceivable 
why,  far  more  frequently  than  in  any  other  infectious  disease,  at  one 
time  the  patient  promptly  yields  to  the  destroyer,  and  again,  under  what 
appear  to  us  to  be  similar  conditions,  he  experiences  hardly  any  grave 
consequences.  Between  these  extremes  lies  a wide  territory  of  an  end- 
less number  of  disorders,  that  can  involve  nearly  all  the  organs  of  the 
body.  It  is  certainly  an  important  consideration  that  other  infections 
show  a more  marked  tendency  to  complicate  the  course  of  scarlet  fever; 
this  being  especially  true  of  the  septic  processes.  This  fact,  however, 
only  renders  certain  features  a little  more  intelligible. 

* * ❖ 

(From  Acute  Contagious  Diseases,  Welch  and  Schamberg.) 

Scarlet  fever  is  highly  contagious  during  the  period  of  eruption,  and 
usually  for  some  time  following  the  disappearance  of  the  rash.  Scarlet 
fever  is  not  only  contagious  before  desquamation  begins,  but  not  infre- 
quently after  it  has  been  completely  terminated.  It  is  probable  that  the 
prolonged  infeetivity  manifested  by  certain  cases  of  scarlet  fever  is  due 
to  the  presence  of  the  scarlatinal  contagion  in  the  secretions  of  the 
throat,  or  in  the  nasal  and  aural  discharges. 

Physicians  connected  with  scarlet  fever  hospitals  not  infrequently  say 
patients  who  have  remained  in  the  hospital  from  eight  to  twelve  weeks, 
give  rise  on  their  return  home  to  other  cases  in  the  same  household.  And 
this  occurs  despite  the  most  careful  disinfection  of  the  body  and  the- 
clothing. 


ISOLATE 

QUARANTINE 

DISINFECT 


SCARLET  FEVER. 


( Scarlatina.  ) 

ITS 

PREVENTION,  RESTRICTION  AND  SUPPRESSION. 
Published  by  tile  Illinois  State  Board  of  Health. 


1911. 


Scarlet  fever,  scarlatina,  scarlet  rash  and  canker  rash  are  all  names 
for  one  and  the  same  disease.  This  disease  is  scarlet  fever,  a wide- 
spread, dangerous,  contagious  disease,  most  destructive  of  child  life. 

Scarlatina  (the  Latin  for  scarlet  fever)  is  not  a modified  or  milder 
form  of  the  disease.  It  is  scarlet  fever  in  either  mild  or  malignant 
form.  There  is  no  such  disease  as  scarlet  rash. 

“Duke’s  disease”  is  a name  given  to  mild  cases  of  scarlet  fever 
which  occurred  in  Chicago  in  January,  1907.  Scarlet  fever  is  scarlet 
fever,  whether  it  be  mild  or  whether  it  be  malignant. 

Scarlet  fever  is  one  of  the  most  contagious  of  all  diseases.  Recoveries 
from  it  are  frequently  incomplete,  so  that  its  effects  continue  throughout 
all  subsequent  life,  leading  often  to  permanent  impairment  of  health. 
Such  effects  not  infrequently  follow  the  mildest  cases. 

The  disease  usually  attacks  children  under  ten  years  of  age,  but  it  may 
occur  at  any  time  of  life.  Children  are  most  liable  to  contract  the 
disease  between  the  second  and  tenth  year. 

The  contagion  of  scarlet  fever  usually  comes  from  direct  inhalation  of 
the  breath  of  the  patient,  or  of  air  charged  with  minute  scaly  particles 
from  the  skin  of  the  patient.  The  contagion  is  in  the  matters  from  the 
skin,  mouth  and  nose,  but  all  the  excretions  of  the  patient  are  more  or 
less  contagious.  The  contagion  is  mostly  to  be  dreaded  at  the  close  of  the 
fever  while  desquamation  (peeling  or  scaling  of  the  skin)  is  going  on. 

The  poison  which  is  contained  in  these  fine  scaly  particles,  which  are 
diffused  with  the  dust  throughout  the  room,  may  retain  its  infective 
properties  for  months  unless  destroyed  by  proper  disinfection.  In  the 


6 


absence  of  daylight  and  currents  of  air,  and  in  a moderate  temperature, 
this  poison  will  retain  its  active  properties  for  years. 

As  in  diphtheria  and  small-pox,  the  poison  will  attack  itself  to  the 
walls  of  the  room  and  to  its  contents,  to  books,  clothing,  toys,  furniture 
and  bedding.  Any  object  which  the  patient  has  touched  is  exceedingly 
dangerous.  The  disease  may  be  transmitted  by  persons  who  have  been 
in  the  sick  room,  although  they  themselves  may  escape.  Milk  may  be 
the  carrier  of  infection,  dairies  adjoining  infected  houses  having  been 
known  to  disseminate  the  poison  and  give  rise  to  epidemics.  Milk  tickets 
and  the  milkman’s  clothing  may  also  convey  the  disease,  and  probably 
often  do. 

Clothing  in  a laundry  may  become  infected  from  that  of  scarlet  fever 
patients.  The  disease  may  be  disseminated  by  letters  or  papers  sent  by 
mail,  and  also  by  dogs  or  cats  that  have  been  near  the  patient. 

Filth,  unsanitary  surroundings  and  imperfect  ventilation  increase  the 
severity  of  the  disease  and  the  danger  of  its  spreading  and  becoming 
epidemic,  also  overcrowding,  together  with  all  agencies  that  depress 
vitality  and  strength. 

As  a rule,  one  attack  protects  a person  from  further  attacks  through 
life,  but  exceptions  to  this  are  not  infrequent. 

Every  case  of  scarlet  fever  is  dangerous  to  life  and  health.  A mild 
case  in  one  person  may  give  rise  to  a most  malignant  case  in  another. 

Scarlet  fever  is  not  one  of  the  diseases  to  which  mothers  can  safely 
expose  their  children  on  the  theory  that  “it  is  better  for  them  to  have  it 
while  they  are  young.”  This  theory  is  indefensible  in  any  disease;  its 
exemplification  in  scarlet  fever  is  little  removed  from  a criminal  act. 

One  reason  for  warding  off  scarlet  fever  is  that  after  childhood  this 
disease  is  not  so  fatal,  and  also  after  childhood  the  liability  to  take  the 
disease  is  very  much  lessened.  It  therefore  happens  that  many  escaping 
the  disease  in  childhood  never  have  it,  although  many  times  exposed  to 
it  later  in  life. 

Because  children  exposed  to  scarlet  fever  do  not  contract  the  disease, 
it  must  not  be  concluded  that  the  diagnosis  of  the  physician  was  incor- 
rect, or  that,  as  stated  by  the  neighbors,  the  eruption  was  nothing  but 
“scarlet  rash.”  Scarlet  fever,  although  one  of  the  most  contagious  of 
diseases,  behaves  very  capriciously  at  times.  The  immunity  to  the  disease 
enjoyed  by  certain  families  is  inexplicable  as  is  the  reason  for  th&  Severity 
with  which  it  attacks  others.  In  a household  where  there  are  several 
children,  some  are  apt  to  escape,  although  all  have  been  equally  exposed. 
Again,  the  slightest  momentary  exposure  may  be  sufficient  to  cause  the 
disease. 


7 


PREVENTION. 

Scarlet  fever  is  a preventable  disease,  notwithstanding  its  widespread 
character  and  the  ease  with  which  the  infection  adheres  to  articles  which 
may  pass  from  one  person  to  another.  Carefulness  can  keep  the  infection 
from  being  scattered  abroad,  and  disinfection  can  destroy  its  power  to 
do  harm. 

Keep  children  away  from  the  disease  and  from  all  persons  and  things 
that  have  been  where  the  disease  is.  Keep  also  all  persons  who  have 
recently  been  sick  with  the  disease  and  all  who  have  been  where  it 
is,  away  from  your  children.  If  children  from  an  infected  family  are 
allowed  to  attend  school,  withdraw  your  children  from  that  school,  and 
notify  the  State  Board  of  Health.  If  scarlet  fever  has  occurred  in  a 
school  and  the  same  school  has  not  been  disinfected,  take  your  children 
out  of  the  school  and  notify  the  State  Board  of  Health  of  the  facts. 

Be  careful  of  books,  toys  and  all  articles  which  may  have  been  handled 
by  a scarlet  fever  patient.  The  disease  has  been  spread  by  circulating 
libraries,  picture  books  having  been  taken  therefrom  to  amuse  patients, 
and  returned  without  being  disinfected. 

See  that  your  house  and  premises  are  perfectly  clean.  Look  to  your 
cellars,  sewers,  cess-pools,  sinks  and  water  closets,  and  allow  no  decaying 
animal  or  vegetable  matter  to  poison  the  atmosphere  of  your  dwelling. 
Use  disinfectants  freely;  burn  all  rubbish. 

Whatever  you  undertake  to  do,  do  at  once.  “Intentions,  like  eggs, 
unless  hatched  into  action,  will  run  into  rottenness.” 

Beware  of  any  one  with  a sore  throat;  do  not  allow  your  children 
to  be  kissed  by  such  a person,  or  to  drink  from  the  same  cup. 

When  scarlet  fever  is  present  in  your  community,  do  not  take  children 
to  crowded  assemblies.. 

When  disease  prevails  in  the  neighborhood,  and  at  all  times,  warn 
your  children  not  to  use,  while  in  school,  the  pencils,  books,  etc.,  of 
other  children,  and  especially  not  to  put  into  their  mouths,  pencils,  toys, 
harmonicas,  jewsharps,  and  the  like,  which  may  have  been  handled  by 
other  children.  Warn  them  also  to  thoroughly  rinse  the  school  room 
drinking  cup  before  using. 

All  persons  recovering  from  scarlet  fever  are  dangerous.  Dangerous 
also,  and  but  in  a slightly  less  degree,  are  all  individuals,  nurses,  attend- 
ants, parents,  brothers,  sisters,  other  relatives,  friends,  acquaintances, 
neighbors,  who  have  come  in  contact  with  the  patient,  or  who  have  been 
in  the  infected  rooms  prior  to  disinfection  of  the  same,  unless  their 
clothing  and  persons  have  been  disinfected. 


8 


RESTRICTION. 

During  the  existence  of  scarlet  fever  or  diphtheria  in  a community, 
all  cases  of  sore  throat  with  fever  are  to  be  looked  upon  with  suspicion 
until  their  innocent  character  is  established. 

Whenever  a child  has  sore  throat  and  fever,  he  or  she  should  be  at 
once  separated  from  other  members  of  the  family  until  a physician  has 
passed  an  opinion  on  the  nature  of  the  ailment.  This  precaution  should 
never  he  neglected,  especially  if  the  child  vomits  or  has  a chill,  and 
more  especially  if  the  face  be  flushed  or  an  eruption  appears  on  any 
part  of  the  body.  By  “separated”  is  meant  placed  in  a room  apart  as 
far  as  possible  from  other  rooms  in  the  house.  From  this  room  all  other 
children  must  be  kept. 

A child  is  attacked  with  scarlet  fever  usually  within  two  or  four  days 
after  exposure.  The  disease  may  come  on  within  twenty-four  hours  after 
the  child  has  come  in  contact  with  the  poison,  and  again  no  symptoms 
may  develop  until  the  eighth  or  tenth  day.  If  a child  does  not  show 
signs  of  illness  by  the  tenth  day,  it  can  be  safely  concluded  that  the 
disease  has  not  been  contracted.  A child  known  to  have  been  exposed 
should  be  carefully  watched  for  a week  or  ten  days  and  on  the  slightest 
sign  of  illness  be  separated  from  all  others. 

The  symptoms  of  scarlet  fever  vary  with  the  type  and  severity  of  the 
fever.  The  onset  of  the  disease  ordinarily  is  sudden  and  active.  The 
child  feels  uncomfortable,  looks  stupid  and  complains  of  sore  throat, 
which  may  be  very  severe  and  present  all  features  of  a severe  diphtheria. 
There  may  also  be  intense  swelling  of  the  throat  and  neck.  There  is 
a high  fever  and  vomiting  in  the  majority  of  cases.  The  pulse  is  rapid 
and  hard.  A chill  rarely  occurs,  but  in  young  children  convulsions  are 
common.  Sometimes  the  patient  will  have  a more  or  less  severe  head- 
ache, pain  in  the  back  and  limbs,  and  at  first  coldness  of  the  skin. 
Diarrhoea  is  not  uncommon.  The  face  is  often  flushed,  as  a rule  the 
skin  is  very  dry  and  hot,  the  tongue  is  furred  at  the  center  and  red  at 
the  edges  and  tip. 

The  eruption  in  scarlet  fever  usually  appears  first  on  the  neck  and 
chest,  hut  it  may  come  out  on  the  abdomen,  the  hack  of  the  hands  or 
the  thighs.  An  eruption  following  any  of  the  symptoms  outlined  must 
be  regarded  with  apprehension,  no  matter  where  it  appears.  It  is  a 
dangerous  signal,  a disregard  of  which  may  sacrifice  the  child’s  life.  Do 
not  disregard  this  signal ! 

Scarlet  fever  is  infectious  (contagious,  communicable)  from  the 
appearance  of  the  earliest  symptoms  until  desquamation  (peeling  off, 
scaling)  has  ceased,  and  all  signs  of  inflammation  in  the  throat,  nose 
and  ears  have  passed  away. 


9 


SUPPRESSION. 

Engage  the  services  of  a competent  physician  early  in  all  contagious 
diseases.  Do  not  wait  until  it  is. too  late,  when  regrets  are  useless.  You 
may  not  feel  able  to  incur  the  necessary  expense  incident  to  sickness; 
you  likewise  may  not  feel  able  to  pay  those  always  attendant  upon  death. 

Remember  that  scarlet  fever  is  a preventable  disease.  Remember  also 
that  the  period  of  sickness  can  be  much  shortened  and  the  possible  bad 
effects  of  the  disease  entirely  prevented,  if  competent  medical  attendance 
is  obtained  early. 

“Delay  always  breeds  danger.” 

The  Sick  Room — The  room  selected  for  a patient  should  be  large, 
easily  ventilated,  and  as  far  from  the  living  and  sleeping  rooms  of  the 
other  members  of  the  family  as  practicable.  A room  on  the  top  floor 
is  preferable. 

This  room  should  be  prepared  by  removing  from  it  all  superfluous 
clothing  and  furniture,  carpets,  rugs,  draperies,  ornaments,  books,  etc. ; 
in  short,  everything  not  absolutely  needed  for  the  comfort  of  the  sick 
or  the  convenience  of  the  attendants.  Closets  connected  with  the  sick 
room  should  be  emptied  of  their  contents.  The  doors  connecting  with 
halls  or  with  other  rooms  should  be  covered  with  sheets  of  cheap  cotton 
cloth  kept  wet  with  a solution  of  carbolic  acid  (two  and  a half  ounces 
of  the  strong  solution  of  the  acid  to  one  gallon  of  water)  or  with 
Standard  Disinfectant  No.  3,  mentioned  on  last  page  of  this  circular. 
Over  the  door  to  be  used  the  sheet  must  not  be  tacked  at  the  bottom 
nor  along  the  full  length  of  the  lock  side  of  the  frame,  but  about  five 
feet  may  be  left  free  to  be  pushed  aside;  this  sheet,  however,  must  be 
long  enough  to  allow  10  or  12  inches  to  lie  in  folds  on  the  floor  and  must 
also  be  kept  wet  with  the  disinfectant. 

If  time  will  allow,  the  room  should  be  thoroughly  cleaned  before  the 
admission  of  the  patient.  Disinfect  at  once  in  the  manner  herein  directed, 
the  room  previously  occupied  by  the  patient. 

The  sick  room  should  be  well  ventilated,  for  fresh  air  is  an  important 
agent  in  rendering  the  contagious  element  of  scarlet  fever  less  powerful. 
The  patient,  however,  must  be  scrupulously  guarded  against  drafts,  for 
cold  is  often  the  exciting  cause  of  severe  complications  in  the  disease. 
In  cold  weather,  whenever  it  is  possible,  there  should  be  an  open  fire  in 
the  room,  even  when  steam,  furnace  or  stove  heat  is  used.  A stove 
makes  the  worst  kind  of  heat  for  a sick  room.  If  a stove  be  used,  a pan 
oi;  kettle  containing  water  should  be  kept  on  it. 

No  other  person  besides  the  nurse  or  necessary  attendants  should  be 
permitted  in  the  room,  and  they  should  take  special  precautions  not 


10 


to  carry  the  infection.  Their  communication  with  the  rest  of  the  family 
should  be  as  restricted  as  possible.  Do  not  permit  the  sick  room  to  be 
made  a place  of  family  gathering. 

The  attendants  should  wear  only  such  clothing  as  can  be  washed,  and 
should  not  come  in  contact  with  other  members  of  the  family,  especially 
children,  without  first  changing  clothing  and  disinfecting  the  person — 
the  face,  hair  and  hands,  especially. 

Neither  the  nurse  or  any  other  person  should  eat  or  drink  anything 
in  the  sick  room,  or  anything  which  has  been  there.  Food  which  the 
patient  has  left  should  be  burned  or  disinfected.  The  dishes  which  the 
patient  uses  should  not  be  used  by  others,  or  washed  with  other  dishes. 
They  should  be  washed  by  themselves  in  boiling  water. 

While  the  liberal  use  of  liquid  disinfectants  is  recommended,  there 
should  not  be  any  attempt  to  disinfect  the  room,  when  occupied,  by 
the  use  of  votaile  chemical  agents,  such  as  carbolic  acid,  chlorine,  etc. 
It  can  not  be  done,  and  you  but  waste  your  time  and  annoy  the  patient. 
Neutralizing  odors  by  creating  others  does  not  constitute  disinfection. 
Fresh  air  and  absolute  cleanliness  are  all  that  is  necessary.  Your ' 
physician  may  recommend  the  distillation  of  carbolic  acid  in  the  rooir 
by  means  of  boiling  water  to  prevent  the  passage  of  the  virus  in  the 
air.  This  will  be  beneficial  and  can  do  no  harm  unless  the  odor  worries 
the  patient.  In  this,  as  in  all  other  matters,  follow  your  physician’s 
advice.  He  desires  that  his  patient  shall  recover  and  recover  speedily. 

The  contagion  is  contained  in  all  the  excretions  of  the  patient,  and  in 
the  bran-like  scales  of  the  outer  skin  that  are  shed  so  freely  in  conva- 
lescence. The  matters  that  come  from  the  head,  throat,  nose  and  skin 
are  especially  contagious. 

It  is  an  important  point  to  deal  with  the  contagion  at  its  source  and 
act  promptly,  under  all  circumstances.  Delay  gives  opportunity  for  its 
diffusion.  House  flies  and  other  insects,  by  access  to  the  vessels  contain- 
ing excreta,  may  carry  it  about.  Drying  may  convert  it  into  dust  to  float 
in  the  air.  Destroy  the  infection  at  the  point  of  origin,  if  possible. 

“Whatever  thou  takest  in  hand  remember  the  end,  and  thou  shall 
never  do  amiss.” 

All  discharge  from  the  bowels  should  be  received  in  vessels  containing 
a quart  of  Standard  Disinfectant  No.  1*  (either  lime  or  acid),  and 
should  be  left  in  the  vessel  for  an  hour  before  being  thrown  into  privy 
vault  or  water  closet.  The  vomit  matter  and  discharge  from  the  lungs 
and  throat  should  be  received  in  vessels  containing  the  same  solution. 
Have  this  disinfectant  continually  on  hand  ready  for  use. 


*See  last  page  for  method  of  making  and  using  the  Standard  Disinfectants. 


11 


A disinfecting  solution  (carbolic  acid  6^  ounces,  water  1 gallon) 
should  be  always  at  hand  for  washing  the  floor  or  bed  whenever  soiled 
by  discharges. 

The  discharges  from  the  throat,  mouth  and  nose  are  especially  danger- 
ous and  must  be  cared  for  at  once.  It  .is  well  to  prepare  a number 
of  squares  of  old  soft  cloth  (old  sheets  or  pillow  cases)  to  receive  the 
discharges.  The  cloths  should  be  burned  as  soon  as  soiled.  If  there  is 
no  fire  in  the  sick  room  it  is  convenient  to  have  a small  tub,  containing 
the  disinfectant  solution,  to  receive  these  cloths  until  they  can  be  carried 
from  the  room  and  burned. 

All  knives,  forks,  spoons,  glasses,  cups  and  plates  used  by  the  patient 
must  be  disinfected  at  once  by  being  put  in  a carbolic  acid  solution  and 
later  boiled. 

A wooden  pail  or  tub  containing  Standard  Disinfectant  No.  3 should 
be  kept  in  the  room,  and  all  blankets,  sheets,  towels,  pillow  slips  and 
other  articles  used  about  the  patient’s  room  should  be  put  into  this  as 
soon  as  they  are  used  and  before  they  are  taken  from  the  room.  They 
should  be  allowed  to  soak  for  two  hours,  then  they  must  be  taken  out  and 
boiled  at  once.  Use  old  blankets  on  the  bed  and  burn  them  afterwards. 

Dust  and  dirt  must  be  removed  by  cloths  dampened  with  Standard 
Disinfectant  No.  3,  as  sweeping  and  dusting  are  objectionable.  These 
cloths  should  be  at  once  thrown  into  the  solution  or  into  the  fire. 

Books,  toys  and  articles  used  to  amuse  the  patient  when  convalescent 
are  best  disposed  of  by  burning  them  in  the  room.  Under  no  circum- 
stances should  toys  be  borrowed  to  return,  to  be  used  by  the  well.  Never 
return  a booh  taken  from  a public  library.  It  must  be  burned. 

“In  a serious  trust  negligence  is  a crime.” 

Toward  the  end  of  the  active  stage  of  scarlet  fever,  the  skin  usually 
peels  off ; this  may  occur  in  flakes  of  considerable  size,  in  tiny  scales, v or 
in  an  almost  impalpable  powder.  Whichever  may  be  the  case,  these 
particles  of  skin  act  as  carriers  of  the  disease,  floating,  as  they  may  do, 
in  the  air,  or  finding  lodgment  in  the  clothing,  in  crevices  in  the  floor 
or  walls,  or  in  undusted  corners,  whence  at  some  even  remote  future  day 
they  may  cause  a new  outbreak  of  the  disease.  Frequent  anointing  of 
the  entire  body  of  the  patient  at  this  period  of  the  disease  with  cosmoline, 
sweet  oil,  fresh  lard  or  some  other  unguent  will  prove  grateful  to  him, 
and  by  mechanically  imprisoning  the  particles  of  skin,  will  do  much  to 
prevent  danger.  This  anointing  should  always  be  done,  and  will  always 
be  directed  by  the  attending  physician.  The  entire  surface  of  the  body 
may  be  bathed  daily  as  directed  by  the  physician. 


12 


No  person  from  a house  where  scarlet  fever  is  should  go  into  public 
assemblies,  such  as  schools,  churches  or  concerts,  or  anywhere  into  the 
presence  of  children.  No  person  in  said  house  should  leave  the  premises 
without  first  thoroughly  washing  his  hands,  face  and  hair,  and  brushing 
his  clothing  with  a whisk  broom  wet  with  Standard  Disinfectant  No.  3. 

Persons  who  have  had  scarlet  fever  should  not  be  allowed  to  go  to 
school  or  to  mingle  in  any  other  way  with  the  public  while  they  remain 
infectious.  They  should  be  considered  infective  for  five  weeks  at  least, 
and  in  many  cases  the  period  of  desquamation,  or  peeling,  and  of  infec- 
tiousness is  extended  to  six  or  eight  weeks.  The  period  of  infectiousness 
may  be  prolonged  indefinitely  when  thorough  disinfection  is  neglected. 

“Nothing  is  more  terrible  than  active  ignorance.” 

Before  going  to  school  or  to  any  meeting,  the  patient  should  have  a 
health  certificate  from  the  physician  or  health  officer  setting  forth  that 
proper  precautions  have  been  taken  during  the  sickness,  and  that  the 
person  is  believed  to  be  free  from  danger  of  conveying  the  disease  to 
others. 

All  clothing  of  the  patient  should  be  disinfected  before  it  is  worn 
again.  The  clothing  the  patient  was  wearing  when  taken  sick  should 
he  disinfected  at  once  and  put  away. 

In  the  event  of  death,  the  body  must  be  wrapped  in  a sheet  thoroughly 
soaked  in  Standard  Disinfectant  No.  2,  and  then  placed  in  an  air  tight 
coffin.  Public  funerals  and  wakes  over  such  a body  are  forbidden.  The 
coffin  must  not  be  opened  nor  the  remains  again  exposed  under  any  pre- 
text whatsoever.  The  body  cannot  be  transported  by  rail  unless  prepared 
in  accordance  with  the  rules  of  this  Board  and  placed  in  an  air  tight 
metallic  casket.  Newspaper  notices  of  such  deaths  shalf  distinctly  state 
the  deceased  died  of  scarlet  fever. 


DISINFECTION  OF  HOUSES. 

A very  wholesome  practice  that  bids  fair  to  become  an  established 
custom  is  the  disinfection  of  a rented  house  before  a new  family  moves 
into  it.  This  is  done  now,  where  a case  of  very  contagious  disease,  say 
small-pox,  or  diphtheria,  has  been  known  to  exist;  but  how  can  we  feel 
sure  that  the  house  we  are  about  to  move  into  and  live  in  has  not  had  in 
it  an  unrecognized  or  a suppressed  case  of  measles,  scarlet  fever,  or 
tuberculosis,  or  typhoid  fever?  Disinfection  after  these  diseases  is  of 
the  highest  importance.  Then,  again,  there  are  those  diseases  that  are 
not  fatal,  perhaps,  but,  being  communicable,  may  become  certainly  afflic- 
tions, nuisances.  This  precaution,  therefore,  should  be  demanded  of 
every  landlord,  by  those  who  are  planning  to  rent  the  house. — Public 
Heal tli,  Michigan. 


18 

DISINFECTION. 

When  an  apartment  which  has  been  occupied  by  a person  sick  with  an 
infectious  disease  is  vacated  it  should  be  disinfected. 

1.  The  work  of  disinfection  should  begin  with  the  beginning  of  the 
treatment  of  cases  and  should  continue  during  the  whole  course  of 
the  disease.  All  articles  of  bed  clothing  and  of  body  clothing  should 
be  disinfected  as  soon  as  they  are  removed  from  the  bed  or  from  the 
patient. 

2.  During  the  entire  illness,  the  privy  should  be  thoroughly  disin- 
fected with  Standard  Disinfectant  Xo.  1,  four  or  five  gallons  of  which 
should  be  thrown  into  the  vault  every  day.  Instead  of  the  solution, 
chloride  of  lime  in  powder  can  be  used.  All  woodwork  in  the  vault  should 
be  soaked  with  the  solution  or  covered  with  powdered  lime.  Water 
closets  and  sinks  should  be  disinfected  daily  by  pouring  a quart  or 
more  of  the  solution  of  chloride  of  lime  or  carbolic  acid  into  the  pipes. 
The  pipes  should  be  freely  flushed  in  order  to  avoid  injury. 

The  object  of  disinfection  in  the  sick  room  is  the  destruction  of  infec- 
tious material  attached  to  clothing,  carpets,  draperies,  furniture  or 
surface  of  the  room,  deposited  as  dust  upon  the  window  ledges,  in 
crevices,  etc.  If  the  room  has  been  properly  cleansed  and  ventilated 
while  still  occupied  by  the  sick  person,  and  especially  if  it  was  stripped 
of  carpets  and  unnecessary  furniture  at  the  onset  of  the  attack,  the  diffi- 
culties of  disinfection  will  be  greatly  reduced. 

After  the  patient  has  been  removed  from  the  room,  it  should  be 
thoroughly  fumigated,  with  all  its  contents,  by  burning  sulphur  or 
evaporating  formaldehyde,  and  by  a thorough  cleansing  with  a disin- 
fectant solution. 

• The  following  mode  of  procedure*  will  be  found  easy  of  application, 
economical  and  effective: 

“Whatever  is  Worth  Doing  is  Worth  Doing  Well.” 

(a)  Have  all  windows  and  doors  (except  door  of  egress)  tightly 
closed.  Securely  paste  strips  of  paper  over  keyholes,  over  cracks,  above, 
beneath  and  at  sides  of  windows  and  doors.,  over  stove  holes  and  all 
openings  in  walls,  ceiling  and  floor.  If  opening  be  large,  paste  several 
thicknesses  of  paper  over  opening.  Carefully  stop  up  the  fire  place,  if 
there  be  one.  There  must  be  no  opening  through  which  gas  can  escape. 

(b)  All  articles  in  the  room  that  cannot  be  washed  must  be  spread 
out  on  chairs  or  racks.  Clothing,  bed  covers,  etc.,  should  be  hung  on 
lines  stretched  across  the  room.  Mattresses  should  be  opened  and  set 


*See  pages  26  and  27,  for  method  of  disinfection  with  formaldehyde. 


14 


on  edge.  Window  shades  and  curtains  spread  out  at  full  length.  If 
there  is  a trunk  or  chest  in  the  room,  open  it,  but  let  nothing  stay  in  it. 
Open  the  pillows  so  that  the  sulphur  fumes  can  reach  the  feathers.  Do 
not  pile  articles  together. 

(c)  Use  three  pounds  of  powdered  sulphur  for  every  1,000  cubic  feet 
in  the  room.  A room  10  feet  long,  10  feet  wide  and  10  feet  high  has 
1,000  cubic  feet.  For  a closet  use  two  pounds  of  sulphur. 

(d)  Burn  the  sulphur  in  an  iron  pot  or  deep  pan.  Let  the  pot  or 
pan  stand  in  a large  vessel  containing  water,  which  vessel  should  be 
placed  on  a table,  not  on  the  floor.  For  example,  take  a common  wash 
tub,  lay  in  it  three  or  four  .bricks,  pour  in  water  to  the  level  of  top  of 
bricks,  put  the  pot  or  pan  containing  the  required  amount  of  sulphur 
on  the  bricks,  place  the  wash  tub  and  contents  on  a table.  The  disin- 
fecting “apparatus”  is  then  in  working  order. 

Moisten  the  sulphur  with  alcohol  and  ignite.  When  the  sulphur  begins 
to  burn,  leave  the  room,  close  the  door  of  egress,  and  carefully  paste 
strips  of  paper  over  the  keyhole  and  all  openings  above,  beneath  and 
at  side  of  door.  Keep  the  room  closed  for  ten  hours  at  least. 

Sulphur  candles  may  be  used  instead  of  crude  sulphur,  but  care  must 
be  taken  to  use  sufficient  candles.  The  average  candle  on  the  market 
contains  one  pound  of  sulphur.  Three  of  these  will  be  required  in  the 
disinfection  of  a small  room,  10x10x10.  Do  not  use  a less  number,  no 
matter  what  directions  may  accompany  the  candle.  The  water  jacketed 
candle  is  preferable.  Partly  fill  tin  around  candle  with  water  and 
place  candles  in  a pan  on  the  table,  not  on  the  floor.  Let  one-half  pint 
of  water  be  vaporized  with  each  candle.  In  the  absence  of  moisture,  the 
fumes  of  sulphur  have  no  disinfecting  power. 

(e)  After  the  apartments  are  opened,  take  out  all  articles  and  place 
them  in  the  sunshine.  Carpets  should  be  well  beaten  and  exposed  to 
the  sun. 

“Lingering  labor  often  comes  to  naught.” 

(f)  All  surfaces  in  the  room  should  then  be  thoroughly  washed  with 
Standard  Disinfectant  No.  3.  Walls  and  ceiling,  if  plastered,  should 
subsequently  be  washed  with  lime.  Wash  well  all  out  of  the  way  places, 
window  ledges,  mouldings,  etc.  Floors,  particularly,  should  receive 
careful  treatment,  and  the  solution  should  wet  the  dust  and  dirt  in  the 
cracks. 

(g)  After  washing,  ventilate  the  rooms,  if  possible,  for  several  hours, 
then  scrub  all  woodwork  with  soap  and  hot  water. 

(h)  It  is  safer  to  burn  mattresses  and  pillows. 


15 


(i)  It  is  likewise  safer  to  burn  all  books,  toys  and  articles  of  small 
value  which  have  been  handled  by  the  patient.  Burn  what  you  cannot 
boil.  Books  which  have  not  been  handled  by  the.  patient  can  be  saved. 
Lay  them  on  edge  on  a table  with  leaves  open,  in  a room  while  the 
sulphur  is  burning. 

Overdo  rather  than  underdo. 

Unless  all  precautions  recommended  have  been  taken  in  the  sick  room, 
the  entire  house  must  be  disinfected  in  the  manner  directed  for  the  sick 
room;  otherwise  a thorough  “cleaning  house”  exposure  of  all  articles  to 
air  and  sunshine,  the  beating  of  carpets,  etc.,  will  be  all  that  is  necessary. 
In  case  the  entire  house  is  disinfected,  take  out  before  exposure  to  sul- 
phur any  pianos,  sewing  machines,  lace  curtains,  fine  paintings  or 
draperies  and  expose  them  to  the  sun.  Sulphur  fumes  injure  these 
articles. 

The  infection  must  not  remain  in  the  house.  It  is  a menace  to  the 
lives  and  health  of  the  patient,  the  children,  if  any,  of  the  family  and 
your  neighbor’s  children. 

There  is  one  serious  objection  to  the  use  of  sulphur,  and  this  must  be 
fully  understood.  The  fumes  of  sulphur  have  a destructive  action  on 
fabrics  of  wool,  silk,  cotton  and  linen,  on  tapestries  and  draperies,  and 
exercise  an  injurious  influence  on  brass,  copper,  steel  and  gilt  work. 
Colored  fabrics  are  frequently  changed  in  appearance  and  the  strength 
impaired.  Fabrics,  however,  can  be  effectually  disinfected  by  hanging 
them  on  a line  exposed  to  the  sun  and  wind  for  several  days.  Curtains 
and  all  articles  of  cotton  or  linen,  boiling  or  soaking  them  in  Standard 
Disinfectant  No.  3 for  several  hours,  and  portable  articles  of  brass,  cop- 
per, steel  and  gilt  work  by  washing  with  a strong  solution  of  carbolic 
acid  (Standard  Disinfectant  No.  1). 

Formaldehyde  (the  40  per  cent  solution)  may  be  used  instead  of  sul- 
phur, if  desired.  See  pages  26  and  27  for  method  of  application. 

DISINFECTANTS. 

Next  to  isolation , disinfection  is  of  the  most  importance  in  restricting 
the  spread  of  scarlet  fever.  By  the  intelligent  use  of  disinfectants  the 
family  and  the  public  are  protected  against  the  infection  of  the  disease. 

Much  of  the  so-called  disinfection  practiced  in  families  is  wholly 
inefficient  and  useless.  The  burning  of  coffee,  tar,  sulphur,  or  other 
substance  in  the  sick  room  or  in  any  other  part  of  the  house  or  premises 
in  the  presence  of  the  patient  or  other  persons  operates,  at  most,  only 
as  a deodorizer,  and  does  not  destroy  the  germs  of  the  disease. 

It  should  also  be  known  that  many  of  the  preparations  offered  for  sale 
as  disinfectants,  germ  killers,  etc.,  are  worthless,  or  nearly  so,  and  should 
never  be  relied  upon. — Bulletin  New  Hampshire  State  Board  of  Health. 


APPARATUS  FOR  GENERATING  FORMALDEHYDE  GAS. 

(Formaldeh)  de-Potassium  permanganate  method. 

See  page  26.) 


17 


PUBLIC  HEALTH  LAWS  OF  ILLINOIS. 


EXTRACTS  FROM  THE  REVISED  STATUTES. 


Powers  and  Authority  of  the  State  Board  of  Health. 

(Extract.) 

The  State  Board  of  Health  shall  have  the  general  supervision  of  the  inter- 
ests of  the  health  and  life  of  the  citizen  of  the  State.  They  shall  have 
charge  of  all  matters  pertaining  to  quarantine;  and  shall  have  authority  to 
make  such  rules  and  regulations,  and  such  sanitary  investigations,  as  they 
may  from  time  to  time  deem  necessary  for  the  preservation  or  improvement 
of  public  health;  and  it  shall  be  the  duty  of  all  police  officers,  sheriffs,  con- 
stables, and  all  other  officers  and  employes  of  the  State,  to  enforce  such  rules 
and  regulations,  so  far  as  the  efficiency  and  success  of  the  Board  may  de- 
pend upon  their  cooperation.  [ Revised  Statutes,  Chap.  126a,  Sec.  2.] 


POWERS  OF  CITY  COUNCILS  IN  CITIES  AND  PRESIDENTS  AND  BOARDS  OF'  TRUSTEES 
IN  VILLAGES  INCORPORATED  UNDER  THE  GENERAL  LAW. 


[Revised  Statutes,  Chap.  24,  Sec.  62 .] 

(Extracts.) 

Seventy- fifth — To  declare  what  shall  be  a nuisance,  and  to  abate  the  same; 
and  to  impose  fines  upon  parties  who  may  create,  continue  or  suffer  nuisances 
to  exist. 

Seventy-sixth — To  appoint  a board  of  health,  and  prescribe  its  powers  and 
duties. 

Seventy-eighth — To  do  all  acts,  make  all  regulations  which  may  be  neces- 
sary or  expedient  for  the  promotion  of  health  or  the  suppression  of  disease. 

Eighty-first — To  direct  the  location  and  regulate  the  management  and  con- 
struction of  packing  houses,  renderies,  tallow  chandleries,  bone  factories, 
soap  factories  and  tanneries,  within  the  limits  of  the  city  or  village,  and  with- 
in the  distance  of  one  mile  without  city  or  village  limits. 

Eighty-thircl — To  prohibit  any  offensive  or  unwholesome  business  or  estab- 
lishment within  or  within  one  mile  of  the  limits  of  the  corporation. 


18 


Eighty-fourth — To  compel  the  owner  of  any  grocery,  cellar,  soap  or  tallow 
chandlery,  tannery,  stable,  pig  sty,  privy,  sewer  or  other  unwholesome  or 
nauseous  house  or  place,  to  cleanse,  abate,  or  remove  the  same,  and  to  regu- 
late the  location  thereof. 

Ninety-sixth — To  pass  all  ordinances,  rules,  and  make  all  regulations, 
proper  or  necessary,  to  carry  into  effect  the  powers  granted  to  cities  or 
villages,  with  such  fines  or  penalties  as  the  city  council  or  board  of  trustees 
shall  deem  proper:  Provided,  no  fine  or  penalty  shall  exceed  $200,  and  no 
imprisonment  shall  exceed  six  months  for  one  offense. 

Territorial  Jurisdiction — The  city  council  and  board  of  trustees  shall  also 
have  jurisdiction  in  and  over  all  places  within  one-half  mile  of  the  city  or 
village  limits,  for  the  purpose  of  enforcing  health  and  quarantine  ordinances 
and  regulations  thereof. — [ Revised  Statutes,  Chap.  2Jf,  Sec.  44-] 


POWEBS  OF  COUNTY  AND  TOWNSHIP  BOARDS  OF  HEALTH. 

{Act  approved  May  10,  in  force  July  1,  1901.  Amended/  by  act  in  force  July 

1,  1903.1 

(Extracts.) 

Section  1.  The  board  of  county  commissioners  in  counties  not  under  town- 
ship organization,  and  the  supervisor,  assessor  and  town  clerk  of  every  town 
in  counties  under  township  organization,  shall  constitute  a board  of  health, 
and  on  the  breaking  out  of  any  contagious  or  infectious  disease  in  their 
county  or  town,  or  in  the  immediate  vicinity  thereof,  it  shall  be  their  duty 
to  make  and  enforce  such  rules  and  regulations  tending  to  check  the  spread 
of  the  disease  within  the  limits  of  such  county  or  town  as  may  be  necessary; 
and  for  this  purpose  they  shall  have  power  to  quarantine  any  house  or  houses, 
or  place  where  any  infected  person  may  be,  and  cause  notices  of  warning 
to  be  put  thereon,  and  to  require  the  disinfection  of  the  house  or  place: 
Provided,  that  nothing  in  this  act  shall  apply  to  any  territory  lying  within 
the  corporate  limits  of  any  incorporated  city  or  village:  Provided,  further, 
that  in  case  the  board  of  health  of  any  county  not  under  township  organiza- 
tion, or  of  any  township  in  counties  under  township  organization  shall  fail, 
refuse  or  neglect  to  promptly  take  the  necessary  measures  to  preserve  the 
public  health,  or  in  case  any  such  board  of  health  shall  refuse  or  neglect 
to  carry  out  the  rules  and  regulations  of  the  State  Board  of  Health,  that 
thereupon  the  State  Board  of  Health  may  discharge  such  duties  and  collect 
from  the  county  or  township,  as  the  case  may  be,  the  reasonable  costs, 
charges  and  expenses  incurred  thereby. 

§ 2.  The  said  boards  of  health  shall  have  the  following  powers: 

First — To  do  all  acts,  make  all  regulations  which  may  be  necessary  or  ex- 
pedient for  the  promotion  of  health  or  the  suppression  of  disease. 

Second — To  appoint  physicians  as  health  officers  and  prescribe  their  duties. 

Third — To  incur  the  expenses  necessary  for  the  performance  of  the  duties 
and  powers  enjoined  upon  the  board. 

Fourth — To  provide  gratuitous  vaccination  and  disinfection. 

Fifth — To  require  reports  of  dangerously  communicable  diseases. 


19 


§ 3.  Any  person  who  shall  violate,  or  refuse  to  obey,  any  rule  or  regula- 
tion of  the  said  board  of  health,  shall  be  liable  to  a fine  not  exceeding  $200 
for  each  offense,  or  imprisonment  in  the  county  jail  not  to  exceed  six  months, 
or  both,  in  the  discretion  of  the  court. 

All  fines  collected  under  the  provisions  of  this  act  shall  be  paid  into  the 
county  treasury  of  the  county  in  which  the  suit  is  brought,  to  be  used  for 
county  purposes,  and  it  shall  be  the  duty  of  the  State’s  attorney  in  the 
respective  counties  to  prosecute  all  persons  violating,  or  refusing  to  obey, 
the  rules  of  said  local  boards  of  health. 


The  expense  of  quarantine  must  be  borne  by  the  municipality,  or  township 
(or  county  in  certain  instances  in  counties  not  under  township  organization) 
but  for  the  board,  nursing,  medical  assistance,  and  supplies  furnished  to 
patients  the  county  is  liable  if  the  proper  county  officer  has  been  advised 
of  the  needs  of  the  patients. 

* * * 

“In  nearly  all  health  and  quarantine  laws  some  are  put  to  inconvenience 
and  annoyance  and  many,  to  a certain  extent,  are  deprived  of  their  liberty 
and  freedom  of  action.  But,  if  the  public  necessity  requires  it,  the  con- 
venience or  even  liberty  of  the  individual  citizen  must  give  way  for  the 
welfare  of  the  greater  number.  * * * The  good  of  the  many  must  be 

preferred  to  the  convenience  or  supposed  welfare  of  the  few.” — Decision  Ap- 
pellate Court  of  Illinois,  Second  District,  Lawbaugh  vs.  Board  of  Educa- 
tion, 66  111.  App.,  159. 

* * * 

“Where  the  public  health  and  human  life  are  concerned  the  law  requires 
the  highest  degree  of  care.  It  will  not  allow  of  experiments  to  see  if  a less 
degree  of  care  will  not  answer.  The  keeper  of  a furious  dog  or  a mad  bull 
is  not  allowed  to  let  them  go  at  large  to  see  whether  they  will  bite  or  gore 
the  neighbors’  children.  Nor  is  the  dealer  in  nitro-glycerine  allowed,  in  the 
presence  of  his  customers,  to  see  how  hard  a kick  a can  of  it  will  bear  with- 
out exploding.  Nor  is  the  dealer  in  gunpowder  allowed  to  see  how  near  his 
magazine  may  be  located  to  a blacksmith’s  forge  without  being  blown  up. 
Nor  is  one  using  a steam  engine  allowed  to  see  how  much  steam  he  can 
possibly  put  on  without  bursting  the  boiler.  No  more  are  those  in  charge 
of  small-pox  patients  allowed  to  experiment  to  see  how  little  cleansing  will 
answer;  how  much  paper  spit  upon  and  bedaubed  with  small-pox  virus  it  will 
do  to  leave  upon  the  walls  of  the  rooms  where  the  patients  have  been  con- 
fined. The  law  will  not  tolerate  such  experiments.  It  demands  the  exercise 
of  all  possible  care.  In  all  cases  of  doubt  the  safest  course  should  be  pur- 
sued, remembering  that  it  is  infinitely  better  to  do  too  much  than  to  run 
the  risk  of  doing  too  little.” — Decision  Supreme  Court  of  Maine,  Seavey  vs. 
Preble,  64  Me.,  120. 


20 


GENERAL  RULES  AND  REGULATIONS  FOR  PHYSICIANS 
AND  HEALTH  AUTHORITIES. 


1.  Reports — All  cases  of  scarlet  fever  (scarlatina,  scarlet  rash  or 
canker  rash)  shall  be  reported  by  the  attending  physician  to  the  local 
health  authorities,  city,  village,  township  or  county,  depending  on  the 
location  of  the  patient,  and  by  them  to  the  Secretary  of  the  State  Board 
of  Health  at  Springfield. 

2.  Placarding — Whenever  a case  of  scarlet  fever  (scarlatina,  scarlet 
rash  or  canker  rash)  shall  have  been  reported,  the  infected  house  shall 
be  properly  placarded  and  all  children  therein  confined  to  the  immediate 
premises  during  the  prevalence  of  the  disease.  Steps  shall  be  taken 
to  prevent  all  unauthorized  persons,  especially  children,  from  visiting 
the  premises,  and  adults  from  the  infected  house  shall  be  prohibited 
from  mingling  unnecessarily  with  other  people,  above  all  with  children, 
and  shall  be  required  to  disinfect  their  clothing  before  going  out  of  the 
house. 

3.  Duties  of  Physicians — The  physician  attending  a case  of  scarlet 
fever  (scarlatina,  scarlet  rash  or  canker  rash)  may  be  permitted  to  visit 
the  infected  premises  whenever  necessary,  but  must  take  all  necessary 
precautions  to  avoid  carrying  the  disease  on  his  clothing  or  person. 

4.  Recovery  of  Patient — The  patient  shall  not  be  considered  “entirely 
recovered”  until  pronounced  so  by  a legally  qualified  physician. 

5.  Disinfection — The  infected  premises  with  all  articles  of  furniture 
and  clothing  therein  shall  be  thoroughly  disinfected  as  herein  directed 
before  the  quarantine  shall  be  raised. 

6.  Deaths  and  Funerals — In  the  event  of  death,  the  body  must  be 
wrapped  in  a sheet  thoroughly  soaked  in  Standard  Disinfectant  No.  2, 
and  then  placed  in  an  air-tight  coffin,  which  must  remain  in  the  sick 
room  until  removed  for  burial.  Public  funerals  and  wakes  over  such 
bodies  are  forbidden.  The  coffin  must  not  be  opened  nor  the  remains 
again  exposed  under  any  pretext  whatsoever.  The  body  can  not  be  trans- 
ported by  rail  unless  prepared  in  accordance  with  the  rules  of  this  Board. 
Newspaper  notices  of  such  deaths  should  distinctly  state  that  the  deceased 
died  of  scarlet  fever. 

To  the  living  and  not  the  dead  is  our  duty  due. 


21 


SUGGESTIONS  TO  PHYSICIANS. 

A typical  form  of  scarlatina  offers  few  difficulties  in  diagnosis,  for 
it  can  not  be  mistaken  for  any  other  disease.  In  mild  or  ill-defined  cases 
the  diagnosis  is  not  always  easy,  hut  in  scarlatina  as  in  all  eruptive  dis- 
eases, time  is  a valuable  factor.  The  eruption  of  scarlatina  is  charac- 
teristic, and  that  alone  will  serve  to  distinguish  it  from  other  eruptive 
fevers. 

Scarlatina  is  most  readily  confounded  at  the  onset  of  the  active  period 
with  tonsilitis,  diphtheria,  rotheln,  rubeola,  varicella  and  even  variola. 
Cases  of  acute  exfoliating  dermatitis,  the  various  erythema  and  the  exan- 
thema following  the  ingestion  of  certain  drugs  and  articles  of  food  often 
simulate  the  disease.  The  diagnosis  between  rotheln  and  scarlatina  in 
mild  form  is  frequently  attended  with  difficulty. 

In  the  diagnosis  of  contagious  diseases  great  care  should  be  exercised 
and  the  physician  should  invariably  insist  on  the  temporary  isolation  of 
the  patient  unless  he  is  satisfied  that  the  ailment  is  of  benign  character. 
The  interests  of  the  public  health  require  that  no  less  degree  of  care 
shall  be  exercised. 

On  being  satisfied  that  scarlatina  exists  in  a family  the  attending 
physician  should  recommend  the  observance  of  all  precautions  necessary 
to  prevent  the  further  spread  of  the  disease,  and  should,  as  soon  as 
practicable,  report  the  case  or  cases  to  the  local  board  of  health,  if 
there  be  one;  if  not,  to  the  legally  constituted  health  authorities. 

The  attending  physician  should  avoid  carrying  infection.  This  he 
can  do  if,  after  contact  with  the  patient,  he  washes  his  hair,  beard  and 
all  exposed  cutaneous  surfaces  with  a germicidal  solution,  and  thoroughly 
brushes  his  clothing  with  a whisk  broom  saturated  with  a strong  disin- 
fectant. The  ease  with  which  particles  of  exfoliated  epithelium  are 
disseminated  through  the  air,  and  the  tenacity  with  which  they  adhere  to 
textures,  clothing,  etc.,  makes  this  an  imperative  duty. 

On  the  recovery  of  the  patient  the  attending  physician  should  notify 
the  local  health  authorities  in  order  that  the  quarantine  restrictions  can 
be  removed,  and  should  give  the  patient  proper  certificate  of  recovery. 
The  physician  should  also  impress  upon  the  local  health  authorities  the 
absolute  necessity  for  a thorough  disinfection  of  the  infected  room  or 
rooms,  if  he  has  reason  to  believe  that  this  important  feature  of  pre- 
ventive medicine  will  be  overlooked. 

When  should  the  patient  be*  released  from  quarantine?  The  time 
is  variable,  depending  entirely  upon  the  character  of  the  disease  and 
the  presence  or  absence  of  complications.  As  a general  rule  it  will  be 
proper  to  regard  five  weeks  from  the  rash  as  the  minimum  length  of 
isolation.  Under  no  circumstances  should  the  patient  be  pronounced 


22 


free  from  the  danger  of  conveying  infection  until  desquamation  has 
entirely  ceased  and  all  signs  of  inflammation  of  the  mucous  membranes 
have  passed  away.  Even  then  infection  may  be  conveyed  if  there  is  a 
discharge  from  the  auditory  meatus,  the  dried  and  purulent  matter 
attaching  to  which  being  possibly  as  infective  as  any  purely  cutaneous 
particles. 

While  all  medical  authorities  do  not  agree  on  the  subject,  it  is  the 
opinion  of  the  majority  that  scarlatina  is  infectious  from  the  appearance 
of  the  earliest  symptoms  until  desquamation  has  entirely  ceased.  But 
there  is  little  doubt  that  at  the  very  beginning  of  scarlet  fever  the  con- 
tagiousness is  limited,  and  that  this  disease  is  highly  contagious  during 
the  period  of  eruption  and  desquamation. 

* ❖ * . 

Scarlet  fever  will  not  attack  every  individual  even  though  directly 
exposed  to  the  contagion.  Why  this  is  we  cannot  explain.  In  fact  as 
stated  in  the  extract  from  NothnagePs  Encyclopedia,  published  as  a 
preface  to  this  circular,  “in  none  of  the  acute  exanthemata  does  our 
lack  of  knowledge  of  the  cause  of  the  disease  prove  so  disturbing  a factor 
as  in  scarlet  fever.” 

Speaking  on  the  subject  of  immunity  to  scarlet  fever,  Welch  and 
Schamberg  say : “The  contagion  of  scarlet  fever  is  a most  capricious  one. 
It  may  repeatedly  spare  an  exposed  individual,  only  to  strike  him  at  some 
subsequent  period.” 

That  the  exciting  cause  of  scarlet  fever  is , a micro-organism  there  is 
little  doubt,  although  the  body  described  as  the  “germ”  has  not  been 
definitely  isolated.  But  as  scarlet  fever  is  so  similar  in  its  behavior  and 
manner  of  transmission  to  other  infectious  diseases  of  proven  parasitic 
origin,  we  are  justified  in  assuming  that  the  active  factor  is  a micro- 
organism. 

We  know,  beyond  doubt,  that  the  degree  of  mildness  or  severity  of  a 
case  does  not  influence  that  of  another  caused  by  it,  the  severest  cases 
being  at  times  followed  by  the  mildest  forms,  and  vice  versa. 

In  regard  to  the  transmission  of  scarlet  fever  through  a contaminated 
milk  supply,  Welch  and  Schamberg,  than  whom  there  are  no  better 
authorities,  say:  “From  the  now  extensive  literature  upon  the  subject, 
we  may  conclude  that  scarlatina  may  be  conveyed  through  a contami- 
nated milk  supply.  The  proposition  is  not  proven  beyond  the  peradven- 
ture  of  a doubt,  but  the  chain  of  circumstantial  evidence  is  so  strong 
as  to  render  this  conclusion  almost  irresistible.  It  would,  furthermore, 
appear  that  the  milk  is  contaminated  through  contact  with  an  individual 
suffering  or  convalescent  from  the  disease.  The  view  advanced  by  Klein 
that  the  cows  themselves  suffer  from  scarlatina  remains  unproven  and 
is  not  generally  credited.” 


23 


DUTIES  OF  LOCAL  HEALTH  AUTHORITIES. 

Whenever  a case  of  scarlet  fever  (scarlatina)  is  reported  by  the  house- 
hold or  attending  physician,  the  local  health  officer,  if  there  be  one,  or  a 
physician  appointed  by  the  city,  village  or  town  authorities,  must  visit 
the  premises  and  secure  prompt  compliance  with  the  precautions  herein 
enjoined.  Every  infected  house  should  be  properly  placarded  and  all 
children  therein  confined  to  the  immediate  premises  during  the  prev- 
alence of  the  disease,  and  steps  should  be  taken  to  prevent  all  unauthor- 
ized persons,  especially  children,  from  visiting  the  premises.  Adults  from 
the  infected  house  must  be  prohibited  from  mingling  unnecessarily  with 
other  people,  above  all  with  children,  and  should  be  required  to  disinfect 
their  clothing  before  going  out  of  the  house. 

Isolate,  Quarantine,  Disinfect. 

It  is  not  considered  necessary  to  close  the  schools  during  the  preva- 
lence of  scarlet  fever  in  a community  unless  it  prevails  in  epidemic  form, 
but  the  local  health  authorities  should  notify  the  principals  of  public, 
parochial  and  private  schools  in  the  neighborhood  of  the  existence  of 
the  disease,  and  if  any  children  affected  with  scarlet  fever  have  attended 
school  since  its  appearance,  such  school  or  schools  should  be  promptly 
closed  until  disinfected. 

It  is  imperative  that  similar  notice  be  sent  also  to  the  superintendents 
of  all  Sunday  schools,  or  to  the  pastors  of  the  churches,  for  there  is  no 
question  but  that  the  liability  of  the  dissemination  of  contagious  diseases 
is  greater  in  Sunday  schools,  which  are  used  but  once  a week,  than  in 
public  schools,  which  are  cleaned  and  ventilated  daily.  As  a further 
precautionary  measure  the  local  health  authorities  should  see  that  rooms 
used  for  Sunday  school  purposes  be  kept  in  a sanitary  condition  and 
freely  ventilated  at  intervals  during  the  week. 

On  receiving  a certificate  from  the  attending  physician  that  the  patient 
has  entirely  recovered  and  that  no  further  quarantine  is  necessary,  it 
will  be  the  duty  of  the  local  health  officer  to  see  that  the  infected  room 
and  the  premises,  if  thought  necessary,  with  the  contents,  be  disinfected 
as  directed  herein.  To  be  effective  the  disinfection  must  be  thorough. 
“There  can  be  no  partial  disinfection  of  infectious  material;  either  its 
infectious  power  is  destroyed  or  it  is  not.  In  the  latter  case  there  is  a 
failure  to  disinfect.”  Deodorants  merely  remove  offensive  odors,  and 
may  not  possess  any  disinfecting  power  whatever.  A failure  to  properly 
disinfect  apartments  often  leads  to  the  recurrence  of  the  disease. 

Local  boards  of  health  and  health  officers  should  guard  against  the 
introduction  or  spread  of  contagious  disease  by  the  exercise  of  proper 
and  vigilant  inspection  and  control  of  all  persons  and  things  coming 


24 


within  their  jurisdiction.  They  should  require  prompt  reports  of  all 
infectious  and  contagious  diseases  and  the  isolation  of  all  persons  and 
things  infected  with  or  exposed  to  infectious  or  contagious  diseases,  and 
should  placard  and  disinfect  infected  premises,  close  schools  and  assume 
charge  of  funerals,  if  necessary.  They  should  also  cause  the  arrest  and 
imprisonment  of  all  persons  violating  their  orders.  The  authorities 
may,  in  general,  take  any  measures  of  precaution,  however  stringent, 
which  they  may  deem  necessary  or  prudent  in  the  interest  of  the  health 
of  the  inhabitants.  “The  health  of  the  people  is  the  supreme  law.” 

There  is  no  more  liberal  law  or  charter  in  existence  than  is  given 
to  the  councils  of  cities  and  the  trustees  of  villages  by  section  62,  chapter 
24,  of  the  Revised  Statutes,  for  the  almost  absolute  and  unrestrained 
control  of  the  agencies  affecting  the  public  health.  Concerning  the 
force  and  effect  of  such  the  Supreme  Court  of  Illinois,  in  the  case  of 
Mason  et  al  vs.  The  City  of  Shawneetown,  77  111.,  533,  says:  “When 
an  incorporated  town  or  city  has  been  invested  with  power  to  pass  an 
ordinance,  by  the  Legislature,  for  the  government  or  welfare  of  the 
municipality,  an  ordinance  enacted  by  the  legislative  branch  of  the  corpo- 
ration in  pursuance  of  an  act  creating  the  corporation,  has  the  force 
and  effect  of  a law  passed  by  the  Legislature,  and  can  not  be  regarded 
otherwise  than  as  a law  of  and  within  the  corporation.  An  ordinance  is 
the  law  of  the  inhabitants  of  the  municipality.” 


DISINFECTION. 

The  thorough  disinfection  of  infected  apartments  or  dwelling  is  as 
important  as  the  maintenance  of  an  efficient  quarantine  during  the  preva- 
lence of  the  disease.  Hence,  no  agent  should  be  employed  in  the  effort 
to  destroy  the  germs  of  disease,  upon  the  efficiency  of  which,  under  all 
circumstances,  there  rests  any  doubt  or  uncertainty.  The  use  of  a worth- 
less disinfectant  or  the  misuse  of  a valuable  one  not  only  involves  a waste 
of  time  and  material,  hut  jeopardizes  the  health  of  the  community. 

Disinfection  of  an  infected  apartment  can  be  successfully  performed  by 
thoroughly  wetting  the  floors,  ceilings,  walls  and  all  exposed  surfaces 
with  an  efficient  germicidal  solution.  This  method,  however,  is  not 
applicable  to  the  contents  of  the  apartment.  For  these  fire  is  the  most 
reliable  disinfectant,  yet  as  the  other  reliable  disinfectants  are  available 
there  is  little  justification  for  the  burning  of  any  article  of  value,  except, 
for  instance,  mattresses  or  pillows,  which  can  not  be  successfully  disin- 
fected except  by  steam. 


25 


All  infected  apartments,  with  contents,  should  be  disinfected  by  an 
efficient  aerial  germicide,  and  this  fumigation  should  be  followed  by  a 
thorough  washing  of  the  walls,  ceilings,  floors  and  exposed  surfaces  of  the 
room  with  a reliable  disinfecting  solution. 

Fumigation  by  burning  sulphur  has  for  many  years  been  a favorite 
method  of  aerial  disinfection.  As  stated  in  the  recently  revised  Prize 
Essay  of  the  American  Public  Health  Association,  on  “Disinfectant  and 
Individual  Prophylaxis  Against  Infectious  Diseases/’  by  Surgeon  General 
George  M.  Sternberg,  IT.  S.  A.,  “the  experience  of  sanitarians  is  in  favor 
of  its  use  in  yellow  fever,  small-pox,  scarlet  fever,  diphtheria  and  other 
diseases  in  which  there  is  reason  to  believe  that  the  infectious  material 
does  not  contain  spores.”  In  the  majority  of  the  infectious  diseases, 
the  specific  germ  does  not  form  resistant  spores,  hence  sulphur  dioxide 
would  seem  to  be  a reliable  aerial  disinfectant.  It  must  be  remembered 
also  that  some  authorities  do  not  subscribe  to  the  statement  that  sulphur 
is  powerless  to  destroy  pathogenic  organisms  containing  spores. 

Sulphur  will  be  found  a thoroughly  reliable  gaseous  disinfectant* 
of  considerable  penetrating  power,  if  it  is  intelligently  employed.  To 
obtain  satisfactory  results,  the  following  essentials  of  successful  disin- 
fection, established  by  repeated  experiments,  must  be  observed  : (a)  The 

infected  room,  or  rooms,  must  be  thoroughly  closed,  every  crack  and 
crevice  sealed,  (b)  Sufficient  sulphur  must  be  used,  (c)  There  must 
be  ample  moisture  in  the  room,  (d)  The  time  of  exposure  must  be 
sufficient,  ten  hours  the  minimum. 

In  the  disinfection  of  stores,  halls,  school  houses  and  apartments  or 
dwellings  in  which  there  are  no  articles  to  be  injuriously  affected  by  the 
gas,  sulphur  is  an  ideal  disinfectant.  Its  mode  of  application  is  simple 
(the  simpler  the  mode  of  application  the  better),  it  is  cheap,  the  mate- 
rial is  accessible  everywhere,  and,  finally,  the  most  important  of  all, 
the  action  will  be  invariably  found  effective  when  the  sulphur  has  been 
properly  used. 

During  recent  years,  formaldehyde  gas  has,  to  a very  considerable 
extent,  taken  the  place  of  sulphur  dioxide  as  a gaseous  disinfectant. 
Various  methods  for  the  use  of  formaldehyde  have  been  devised — all 
requiring  apparatus  more  or  less  expensive  and  complicated — all  exploited 
with  extravagant  claims  of  merit  and  infallabilitv.  None  of  these, 
however,  has  proven  worthy  of  the  claims  made  for  it,  while  many  have 
been  entirely  worthless.  The  fact  that  the  vast  majority  of  devices,  at 
one  time  exploited  and  enjoying  wide  popularity,  have  been  eventually 


*See  page  13  for  simple  method  of  application. 


26 


relegated  to  the  junk  heap,  indicates  clearly  the  failure  of  former 
methods  of  formaldehyde  disinfection  to  meet  the  requirements  upon 
them. 

Almost  continuously,  since  1898,  the  State  Board  of  Health  has  expe- 
rimented with  and  investigated  the  merits  of  formaldehyde.  Every 
device  and  every  apparatus  coming  to  the  attention  of  the  Board  has 
been  fairly  and  thoroughly  tested.  In  view  of  the  results  obtained 
with  all,  the  State  Board  of  Health  has  been  unable  to  recommend 
formaldehyde  disinfection  in  the  past,  and  is  only  able  to  recommend  it 
now  when  employed  with  one  method,  and  only  when  this  method  is 
carried  out  as  directed. 

The  method  now  unreservedly  recommended  by  the  Board  consists 
merely  in  pouring  formaldehyde  solution  over  crystals  of  potassium 
permanganate.  This  method  primarily  offers  the  advantage  of  absolute 
simplicity  in  operation,  requiring  no  special  apparatus  and  no  fire.  In 
addition  to  this,  exhaustive  experimental  work  has  demonstrated  that,  in 
practical  disinfection,  the  method  is  unusually  efficient  regardless  of  the 
conditions  of  humidity,  temperature  and  other  factors  which  materially 
effect  other  methods  of  the  use  of  formaldehyde. 

The  only  apparatus  required  is  a large  open  vessel,  protected  by  some 
non-conductive  material  to  prevent  the  loss  of  heat  from  within.  An 
ordinary  milk-pail,  set  into  a pulp  or  wooden  bucket  will  answer  every 
purpose,  although  a special  container,  devised  for  physicians  and  health 
officers  will  be  found  of  considerable  advantage.  This  container  or 
generator  consists  of.  a simply  constructed  tin  can  with  broad  flaring 
top.  Its  full  height  is  1 5%  inches,  the  height  from  the  bottom  to  the 
flaring  top  being  about  8 inches.  The  lower  or  round  section  is  10 
inches  in  diameter,  while  the  flaring  top  is  17%  inches  in  diameter  at 
its  top.  The  container  is  made  of  a good  quality  of  bright  tin,  is  sup- 
plied with  a double  bottom  with  % inch  air  space  between  the  two 
layers  and  is  entirely  covered  on  sides  and  bottom  with  asbestos  paper. 
The  asbestos  paper  and  double  bottom  serve  effectively  to  retain  the 
heat  which  is  generated  by  the  vigorous  chemical  reaction  occurring 
within  and  which  is  essential  to  the  complete  production  and  liberation 
of  the  gas.  This  special  container  can  be  made  by  any  tinner  of  ordinary 
intelligence  and  costs  but  a few  dollars.  It  is  illustrated  on  page  16. 

With  the  room  sealed,  as  described  on  page  13,  and  as  essential  to 
any  form  of  aerial  disinfection,  the  crystals  of  potassium  permanganate 
(6%  ounces  to  each  1,000  cubic  feet  of  room  space,  or  10  ounces  when 
the  temperature  is  below  60°  F.)  are  placed  in  the  container.  Over  this 
salt  is  poured  “formalin,”  or  the  40  per  cent  aqueous  solution  of  for- 


27 


maldehyde  (16  ounces  to  every  1,000  cubic  feet  of  room  space,  or  24 
ounces  when  the  temperature  is  below  60°  F.).  The  formaldehyde  gas 
is  promptly  liberated  by  the  vigorous  chemical  reaction  of  the  formalin 
and  potassic  salt  and  rises  from  the  generator  in  immense  volume  in  the 
form  of  an  inverted  cone.  It  is  consequently  necessary  that  all  prepara- 
tions be  made  in  advance  and  that  the  operator  leave  the  room  at  once 
on  the  combination  of  the  two  chemicals. 

The  door  or  window  of  exit  will  be  promptly  closed  and  sealed  and 
the  room  will  be  left  closed  for  at  least  four  hours. 

As  in  q1!  n.eihods  of  disinfection,  success  largely  depends  upon  the 
care  which  is  exercised  and  the  attention  which  is  given  to  every  detail. 
Simple  as  the  method  is,  neglect  of  any  of  the  following  points  may  result 
in  complete  failure. 

The  sick  room  is  not  the  place  for  experiments. 

1.  The  room  should  be  sealed  and  prepared  as  described  on  page  13. 

2.  The  potassium  permanganate  (6%  ounces  to  every  1,000  cubic 
feet  of  room  space,  or  10  ounces  at  temperatures  below  60°  F.)  should 
be  placed  in  the  apparatus  or  generator.  The  permanganate  must  be 
put  in  before  the  formaldehyde  solution. 

3.  The  40  per  cent  formaldehyde  solution  (16  ounces  to  the  1,000 
cubic  feet  of  room  space,  or  24  ounces  at  temperatures  below  60°  F.), 
should  then  be  poured  over  the  permanganate. 

4.  As  the  gas  is  given  off  in  immense  volume  immediately  after 
the  mixture  of  the  formaldehyde  and  permanganate,  the  operator  must 
leave  the  room  at  once.  All  preparations  must  have  been  finished  in 
advance. 

5.  The  door  or  window  of  exit  must  be  promptly  closed  and  sealed, 
so  that  there  will  be  no  escape  of  gas,  and  the  room  should  be  left 
closed  for  four  hours. 

6.  The  room  should  be  thoroughly  cleaned  after  disinfection.  All 
out-of-the-way  places,  window  ledges,  mouldings,,  etc.,  should  be  washed 
with  Standard  Disinfectant  No.  3 (See  last  page).  The  floors  should 
receive  careful  attention  and  the  solution  should  thoroughly  wet  the  dust 
and  dirt  in  the  cracks. 

“Whatever  is  Worth  Doing  is  Worth  Doing  Well.” 

Whenever  practicable,  the  special  generator,  previously  described, 
should  be  used,  and  health  officers  and  physicians  should  have  several 
such  containers  on  hand.  In  the  absence  of  such  container,  use  a milk- 
pail,  as  described  on  page  26.  If  this  cannot  be  done,  use  a milk-pail,  or 
any  tin  pail,  or  an  earthen  crock,  but  thoroughly  heat  the  pail  or  crock 
.before  putting  in  the  chemicals. 


28 


Care  must  be  taken  not  to  place  too  much  formaldehyde  in  a single 
container.  The  reaction  is  violent  and  there  is  great  effervescence  and 
bubbling.  If  the  room  is  too  large  to  be  disinfected  with  one  generator, 
use  as  many  more  as  may  be  required. 

The  following  quantities  may  be  used  safely  in  the  containers  recom- 
mended : 

10  or  12  quart  milk-pail, 

Formaldehyde,  16  ounces; 

Permanganate,  6%  ounces. 

14  quart  milk-pail, 

Formaldehyde,  24  ounces; 

Permanganate,  10  ounces. 

Special  apparatus  (Described  on  page  22), 

Formaldehyde,  32  ounces; 

Permanganate,  13  y2  ounces. 

If  good  results  are  to  be  attained,  care  must  be  exercised  to  secure 
the  best  quality  of  formaldehyde  solution.  Get  the  highest  grade  40 
per  cent  aqueous  solution  on  the  market.  Good  formaldehyde  is  not 
expensive.  Inferior  formaldehyde  is  dear  at  any  price.  Its  use  may 
bring  about  most  unfortunate  results. 

The  fine,  needle-shaped  crystals  of  potassium  permanganate  are  better 
than  the  rhomboid  crystals.  See  that  yon  get  crystals  of  potassium 
permanganate.  Do  not  accept  the  dust  which  often  contains  impurities. 

Prepare  the  room  and  its  contents  as  described  on  pages  13  and  14, 
but  remember  that  books  cannot  'well  be  disinfected  with  formalde- 
hyde gas. 

Entire  dependence  should,  however,  not  be  placed  upon  any  aerial 
disinfectant  even  though  its  penetrating  power  be  great.  There  should 
be  a thorough  “house  cleaning”  after  the  exposure  to  the  gas,  and  the 
liberal  application  of  a solution  of  corrosive  sublimate  to  all  exposed 
surfaces  in  the  room. 

A copy  of  tliis  circular,  liberal  supplies  of  which  can  be  secured  on 
application  to  the  Secretary  of  the  Board  at  Springfield,  should  be 
furnished  to  every  family  in  which  there  is  a case  of  scarlet  fever 
(scarlatina)  and  to  other  families  which  may  have  been  exposed  to  the 
disease,  and  also  to  teachers  of  public  and  private  schools  and  pastors 
of  churches. 

If  the  spirit  of  the  rules  and  regulations  of  the  State  Board  of 
Health  be  complied  with,  the  disease  can  be  easily  controlled  and  speedily 
suppressed. 

Published  by  order  of  the  State  Board  of  Health. 

James  A.  Egan,  M.  D., 
Secretary. 


29 


STANDARD  DISINFECTANTS. 


The  following  are  simple,  cheap  and  reliable  disinfectants : 

Standard  Disinfectant  No.  1. 

Dissolve  chloride  of  lime  of  the  best  quality , in  water , in  the  proportion 
of  51/2  ounces  to  the  gallon. 

Use  one  quart  of  this  solution  for  each  discharge  from  a patient  suffer- 
ing from  a contagious  or  infectious  disease.  Discharges  from  the  mouth 
and  throat  should  be  received  in  a cup  half  full  of  the  solution,  and  those 
from  the  nostrils  upon  soft  cotton  or  linen  rags  which  should  be  immedi- 
ately burned. 

The  chloride  of  lime  must  be  of  the  best  quality.  Poor  chloride  of 
lime  is  worthless.  The  solution  should  be  made  when  required. 

Instead  of  chloride  of  lime,  carbolic  acid  mav  be  used  in  . the  strength 
of  6i/2  ounces  to  the  gallon  of  water. 


Standard  Disinfectant  No.  2. 

Dissolve  corrosive  sublimate,  and  muriate  of  ammonia  in  water,  in 
the  proportion  of  two  drachms  (120  grains — 1/lf  ounce)  of  each  to  the 
gallon.  Dissolve  in  a wooden  tub , barrel  or  pail  or  an  earthen  crock. 

Use  for  the  same  purposes  and  in  the  same  way  as  No.  1.  It  is  equally 
effective,  but  slower  in  action.  This  solution  is  odorless,  while  the 
chloride  of  lime  solution  is  often  objectionable  in  the  sick-room  on 
account  of  its  smell. 


Standard  Disinfectant  No.  3. 

Dissolve  one  drachm  (60  grains — 1/8  ounce)  of  corrosive  sublimate 
and  muriate  of  ammonia  in  one  gallon  of  water.  Dissolve  in  a wooden 
tub,  barrel  or  pail  or  an  earthen  crock. 

Use  for  the  disinfection  of  soiled  underclothing,  bed  linen,  etc.  Mix 
solution  and  immerse  articles  for  two  hours.  Then  wring  them  out 
and  boil  them. 


30 


Mixed  with  an  equal  quantity  of  water  the  solution  is  useful  for 
washing  the  hands  and  general  surfaces  of  the  bodies  of  attendants  and 
convalescents.  The  latter  only  by  direction  of  the  physician. 

Chloride  of  lime,  carbolic  acid  and  corrosive  sublimate  are  deadly 

poisons. 

^ Solutions  of  corrosive  sublimate  must  not  be  made  or  kept  in  a 
metal  vessel.  Use  a wooden  tub,  barrel  or  pail  or  aft  earthen  crock. 


